Origins of the WHO FCTC by xiaopangnv


									                                                    GLOBAL TOBACCO CONTROL ISSUES 

Origins of the WHO Framework Convention on
Tobacco Control
     The World Health Organi-            | Ruth Roemer, JD, Allyn Taylor, JSD, JD, and Jean Lariviere, MD
  zation (WHO) Framework
  Convention on Tobacco Con-
  trol originated in 1993 with
                                         ON FEBRUARY 27, 2005, THE             PROVISIONS OF THE                        quiring manufacturers and im-
  a decision by Ruth Roemer
  and Allyn Taylor to apply to
                                         World Health Organization             FRAMEWORK                                porters to disclose to governmen-
  tobacco control Taylor’s idea          (WHO) Framework Convention            CONVENTION                               tal authorities the contents and
  that the WHO should utilize            on Tobacco Control (FCTC), the                                                 emissions of tobacco and for gov-
  its constitutional authority to        first treaty ever adopted under          The WHO FCTC is designed              ernments to provide public disclo-
  develop international con-             the auspices of WHO, entered          to strengthen national and inter-        sure of the toxic constituents and
  ventions to advance global             into force. This new treaty is        national coordination to combat          emissions of tobacco products.
  health. In 1995, Taylor and            the first international legal in-     the tobacco epidemic. Formally              The FCTC was designed as a
  Ruth Roemer proposed vari-             strument designed to promote          negotiated by WHO member                 dynamic and incremental ap-
  ous options to WHO, recom-             multilateral cooperation and na-      states over a period of 4 years,         proach to international tobacco
  mending the framework con-
                                         tional action to reduce the           the treaty incorporates a variety        control, modeled on the frame-
  vention-protocol approach
                                         growth and spread of the global       of measures to encourage state           work convention-protocol ap-
  conceptualized by Taylor.
                                         tobacco epidemic. Adopted by          parties to curb the growth of to-        proach that had been used with
     Despite initial resistance
  by some WHO officials, this            consensus by WHO’s 192                bacco production and use, in-            some success, particularly in the
  approach gained wide ac-               member states on May 21,              cluding some measures that con-          realm of environmental law. It
  ceptance. In 1996, the World           2003, this unprecedented              stitute concrete obligations and         was anticipated that over time
  Health Assembly voted to               treaty has been signed by 168         other commitments that are               countries will negotiate and
  proceed with its develop-              states worldwide and is now           framed as goals or recommenda-           conclude protocol agreements—
  ment. Negotiations by WHO              binding international law for         tions. For example, the treaty re-       separate treaties—designed to
  member states led the World            the 57 states that have also rat-     quires that state parties imple-         implement the goals of the
  Health Assembly in May                 ified the FCTC.                       ment restrictions on advertising,        framework convention.
  2003 to adopt by consensus
                                            Tobacco use is one of the          sponsorship, and promotion and
  the WHO Framework Con-
                                         major public health disasters of      implement strong packaging and           GENESIS OF THE
  vention on Tobacco Control—
  the first international treaty
                                         the past century. There are           labeling requirements. The treaty        FRAMEWORK
  adopted under WHO aus-                 more than 1.25 billion smokers        also calls on countries to estab-        CONVENTION
  pices. The treaty formally en-         in the world today, represent-        lish clean indoor air controls and
  tered into force for state par-        ing about one third of the            strengthen legislation to combat            The idea of an international
  ties on February 27, 2005.             world’s population aged older         tobacco smuggling.                       convention for tobacco control
  (Am J Public Health. 2005;95:          than 15 years. Cigarette smok-           Recognizing that price and tax        was born at a July 1993 meeting
  936–938. doi:10.2105/AJPH.             ing is one of the largest causes      measures are effective in reducing       at the UCLA Faculty Center of
  2003.025908)                           of preventable death world-           tobacco consumption, particularly        Ruth Roemer, author of Legisla-
                                         wide and the leading cause of         among young people, the treaty           tive Action to Combat the World
                                         preventable death in industrial-      calls for enacting and implement-        Tobacco Epidemic, Milton I. Roe-
                                         ized countries. However, the          ing tax and price policies on to-        mer, professor emeritus, UCLA
                                         epidemic of disease and death         bacco products that will contribute      School of Public Health, and
                                         is rapidly shifting to developing     to the health objectives aimed at        Allyn L. Taylor, then a visiting
                                         and transitional market               reducing tobacco consumption, al-        professor, Whittier University
                                         economies. At current levels of       though the text stops short of firm      School of School of Law. Im-
                                         tobacco consumption, the epi-         commitments. Similarly, the treaty       pressed by an article by Taylor in
                                         demic is expected to kill about       also calls for testing, measuring,       the American Journal of Law and
                                         10 million people per year by         and regulating the contents and          Medicine in which she had advo-
                                         2020, with two thirds of these        emissions of tobacco products and        cated that WHO utilize its ne-
                                         deaths occurring in developing        for effective legislative, executive,    glected constitutional authority to
                                         countries.                            and administrative measures re-          promote the development and im-

936 | Global Tobacco Control Issues | Peer Reviewed | Roemer et al.                               American Journal of Public Health | June 2005, Vol 95, No. 6
                                                      GLOBAL TOBACCO CONTROL ISSUES 

plementation of international law         on this proposed WHO interna-             Mackay became a key advo-            organization that had never in its
to advance global public health,1         tional legal strategy for tobacco      cate for moving forward action          almost 50-year history utilized
Ruth Roemer suggested to her the          control at the annual meeting of       on an international instrument          its constitutional authority to de-
possibility of applying her ideas to      the Academic Council of the            for tobacco control. Two years          velop a treaty on any matter af-
develop a specific international          United Nations System at the           after the first Roemer–Taylor           fecting global public health. In a
regulatory mechanism for tobacco          Hague.3 At the 9th World Con-          meeting, in May 1995, Mackay            letter to Roemer dated July 28,
control, a field in which WHO             ference on Tobacco or Health in        met with Raoul Uranga of the            1995, a senior WHO official criti-
had a strong, established policy          Paris in October 1994, Roemer          UN Focal Point on Tobacco Con-          cized the Taylor–Roemer pro-
(letter from Ruth Roemer to Allyn         submitted a resolution urging          trol and provided Roemer with a         posal as “ambitious to a fault,”
Taylor, August 18, 1993).                 adoption of an international in-       copy of a memorandum from               emphasized that “it is important
   After the first Roemer–Taylor          strument for tobacco control, and      Erik Crispeels entitled “Interna-       to be realistic,” and encouraged
meeting, Ruth Roemer undertook            Taylor presented a poster de-          tional Measures for the Control         “revising the outline and prepar-
to promote the idea of an interna-        scribing the international legal       of Tobacco: Convention or               ing the background paper.” In
tional legal approach to tobacco          strategy. The resolution, drafted      Code,” dated April 21, 1995 (let-       the following weeks, WHO offi-
control, both nationally and inter-       with the help of Mackay, was           ter from Judith Mackay, May 3,          cials strongly recommended that
nationally. In the summer of              adopted as one of the first resolu-    1995).                                  the authors of the proposal re-
1993, she attended the First All-         tions of the conference.                  In mid-July 1995, Roemer and         consider it and encouraged them
Africa Conference on Tobacco or                                                  Taylor collaborated on a WHO            to recommend either the devel-
Health, cochaired by Derek Yach,          SUPPORT FROM CANADA                    contract to develop a background        opment of a WHO code of con-
then with the Medical Research            AND OTHER MEMBER                       paper to be delivered by Septem-        duct on tobacco control akin to
Council of South Africa, and Tim-         STATES                                 ber 8, 1995, on various options         the WHO International Code of
othy Stamps, then–minister of                                                    for international action on to-         Marketing Breast-milk Substi-
health of Zimbabwe, and pre-                 Shortly after the Paris confer-     bacco control to be undertaken          tutes, a nonbinding international
sented the idea of an international       ence, Jean Lariviere, a senior         by the United Nations in accor-         instrument that could be
legal approach to tobacco control.        medical adviser at Health Can-         dance with WHA resolution               adopted by WHA as a resolu-
Later that year, in October 1993,         ada and a Canadian delegate            48.11.4 A detailed outline of the       tion, or a treaty to be adopted
Roemer visited WHO headquar-              to the World Health Assembly           proposed document was deliv-            under the auspices of the United
ters in Geneva and discussed the          (WHA), was contacted by a              ered to WHO on July 27, 1995,           Nations. Convinced that develop-
idea with senior staff members of         number of Canadians who had            setting forth various options for       ment of a nonbinding code of
several different WHO depart-             attended the world conference          international legal strategy for to-    conduct on tobacco control was
ments. Later that month, she met          and strongly supported the idea        bacco control and recommending          likely to be ineffective and po-
with tobacco control colleagues at        of an “international instrument”       the development and implemen-           tentially counterproductive for
the annual meeting of the Ameri-          for tobacco control. With the          tation of a WHO framework con-          global tobacco control efforts
can Public Health Association and         backing of Jesus Kumate of             vention on tobacco control and          and that WHO, not the United
encouraged them to consider the           Mexico, Kimmo Leppo of Fin-            related protocols to promote            Nations, was the only appropri-
idea. One colleague, Judith               land, and I. A. Mtulia of Tanza-       global cooperation and national         ate forum for the negotiation of
Mackay, the director of the Asian         nia, Lariviere drafted a resolu-       action for tobacco control.             this global public health treaty,
Consultancy for Tobacco Control,          tion that was tabled at the                                                    Taylor and Roemer retained
supported the idea of a tobacco           95th WHO executive board               INITIAL RESISTANCE TO                   their original recommendation.
control treaty and later became a         meeting in January 1995. De-           WHO TOBACCO TREATY                         The final manuscript was sent
key advocate for the convention.          spite some objections, a text                                                  to J. R. Menchaca, WHO’s head
Despite an initial lack of enthusi-       was adopted by the executive              Initially, there was consider-       of tobacco control, on August
asm from most quarters for the            board (EB95.R9) and later by           able resistance among WHO               23, 1995. It proposed the devel-
idea of international law for to-         the WHA (WHA 48.11),4 which            officials who had access to the         opment of a WHO framework
bacco control, Roemer persisted           requested the director general         outline of the Taylor–Roemer            convention on tobacco control
in promoting the idea around the              to report to the 49th World        recommendation formally pro-            and related protocols and recom-
world.                                        Health Assembly on the feasi-      posing the codification and im-         mended substantive and proce-
   Subsequently, Taylor devel-                bility of developing an interna-   plementation of binding interna-        dural mechanisms that could be
                                              tional instrument, such as
oped the idea of the framework                guidelines, a declaration or an    tional law on tobacco control.          included in the proposed conven-
convention-protocol approach to               international convention on to-    Further, there was particular re-       tion to make it an effective in-
tobacco control as part of her                bacco control to be adopted by     sistance to their proposal that         strument of international health
                                              the United Nations, taking into
doctoral dissertation2 and in June            account existing trade and other   such a treaty be developed              policy. The manuscript proposal
1994 presented the first paper                conventions and treaties.          under the auspices of WHO, an           continued to meet substantial re-

June 2005, Vol 95, No. 6 | American Journal of Public Health                               Roemer et al. | Peer Reviewed | Global Tobacco Control Issues | 937
                                                    GLOBAL TOBACCO CONTROL ISSUES 

sistance from most WHO offi-             posed treaty lacked political sup-     important part of the early his-              Contributors
cials and was not published or           port and policy direction at the       tory of the development of the                A. Taylor and R. Roemer jointly wrote
                                                                                                                              most of the article. J. Lariviere contributed
released for distribution by             global level. Not until the elec-      WHO Framework Convention on                   a section and reviewed the article.
WHO until more than a year               tion of Gro Harlem Brundtland          Tobacco Control. In addition to
later.                                   as director general of WHO was         organizing sessions in 1996 and
                                         the implementation of the 1996         1997 that promoted the WHO                    1. Taylor AL. Making the World
WHO EXECUTIVE BOARD                      WHA resolution begun in                treaty, Roemer also sponsored                 Health Organization work: a legal
                                                                                                                              framework for universal access to the
VOICES SUPPORT                           earnest. Immediately upon taking       and secured critical American
                                                                                                                              conditions for health. Am J Law Med.
                                         office in 1998, Brundtland             Public Health Association resolu-             1992;18:301–346.
   The WHO director general              announced her 2 priorities—            tions in support of an effective              2. Taylor AL. An international regula-
issued a brief report for the exec-      tobacco control and combating          WHO framework convention on                   tory strategy for global tobacco control.
utive board meeting of January           malaria. Under Brundtland’s            tobacco control in 1998 and                   Yale J Int Law. 1996;21(2):257–304.

1996, entitled “The Feasibility          tenure, negotiations of the WHO        2001.8,9 Other nongovernmental                3. Taylor AL. The construction of in-
                                                                                                                              ternational public health law. Paper pre-
of an International Instrument           FCTC were undertaken. Re-              agencies offered strong support
                                                                                                                              sented at: the Seventh Annual Meeting
for Tobacco Control” (EB97/INF.          sources were made available to         of the convention.                            of the Academic Council on the United
DOC.4), summarizing the key              the new Tobacco Free Initiative,          The FCTC has the potential                 Nations System, June 24, 1994, The
                                                                                                                              Hague, The Netherlands.
recommendations of the manu-             headed by Yach, to develop a           to act as a global complement to
script.5 At its January 1996             framework convention on to-            regional, national, and local ac-             4. Taylor AL, Roemer R. An Interna-
                                                                                                                              tional Strategy for Tobacco Control. Back-
meeting, the WHO executive               bacco control. The negotiation of      tion for tobacco control. Even                ground Document for the World Health
board considered the summary             the WHO FCTC gained political          before the treaty was adopted,                Organization for WHA 48.11, WHO Doc.
and, despite opposition from the         momentum and turned into a             while the negotiations were in                WHO/PSA/96.6, 1996. Available at
WHO secretariat, the executive           worldwide public health move-          process, a number of govern-                  wha_eb/wha48_11/en. Accessed March
board adopted the resolution “An         ment. The tobacco industry, as         ments took action to strengthen               31, 2005.
International Framework Con-             would be expected, opposed a           their legislation and programs                5. World Health Organization. The
vention for Tobacco Control”             comprehensive treaty, favoring         on tobacco control.10 The final               Feasibility of Developing an Interna-
                                                                                                                              tional Instrument for Tobacco Control,
(EB97.R8). Lariviere served a            voluntary agreements and regu-         text of the treaty, as negotiated
                                                                                                                              Report by the Director General, EM97/
central role in persuading his           lation by the market. In a letter      by WHO member states, neg-                    INF, Doc. 4, 30 November 1995.
member state colleagues on the           dated August 30, 2000, to Gro          lects to incorporate many mech-               6. Letter from Peter Hendrys to Gro
executive board of the feasibility       Harlem Brundtland, director gen-       anisms used in other global                   Harlem Brundtland. Available at: http://
and necessity of this international      eral of WHO, Philip Morris ex-         framework conventions to en-        
regulatory approach to the global        pressed its position on the            courage state parties to comply               Brundtland-letter-8–30-pdf. Accessed
tobacco epidemic. The formal             FCTC.6,7 After listing a number        with their international legal                October 12, 2004.
resolution calling for a WHO             of provisions that it would sup-       commitments. Consequently, ex-                7. Mackay J. The making of a con-
framework convention was                 port [minimum age laws and re-         panded global awareness and                   vention on tobacco control. Bull World
                                                                                                                              Health Organ. 2003,81:551.
cosponsored by Leppo of Finland          tail access prevention programs        national political commitment
and John Hurley of Ireland at the        to keep cigarettes out of the          will be critical to the successful            8. American Public Health Associa-
                                                                                                                              tion Resolutions, Policy Number 9809,
urging of Lariviere, as Canada           hands of minors, reasonable mar-       implementation of this new pub-               “An International Tobacco Control Pol-
was not on the executive board           keting restrictions to prohibit tar-   lic health instrument.                        icy,”1998. Available at: http://www.
in 1996. In May 1996, the                geting minors in tobacco product                                           
WHA adopted the resolution for           marketing, uniform methods for                                                       Accessed April 25, 2005.
the development of a WHO                 testing constituents of tobacco        About the Authors                             9. American Public Health Associa-
framework convention on to-              smoke, reasonable public smok-         Ruth Roemer is with the UCLA School of
                                                                                                                              tion Resolutions, Policy Number
                                                                                Public Health, Los Angeles, Calif. Allyn
bacco control and related proto-         ing restrictions to minimize envi-     Taylor is with the University of Maryland
                                                                                                                              200124, “Tobacco Trust Fund for De-
                                                                                                                              veloping Countries to Meet National
cols (WHA49.16)—the first con-           ronmental tobacco smoke, and           School of Law, and the University of
                                                                                                                              Commitment under the WHO Frame-
vention to be negotiated under           so forth], the letter expressed its    Maryland School of Medicine, Baltimore,
                                                                                                                              work Convention for Tobacco Control,”
                                                                                Md. Jean Lariviere is with the Interna-
the auspices of the WHO.                 opposition to increased taxes on       tional Affairs Directorate/Direction des
                                                                                                                              2001. Available at: http://www.apha.
                                         tobacco products, limitations          Affaires Internationales Health Canada/
PROGRESSION TO                           on free trade, public smoking          Santé Canada, Ottawa, Ontario.
                                                                                                                              Accessed April 25, 2005.
                                                                                    Requests for reprints should be sent to
TOBACCO TREATY                           bans that fail to provide smoking      Allyn Taylor, JD, LLM, JSD, University of     10. Taylor AL. The power of process:
ADOPTION                                 areas, and “shock” images on           Maryland School of Law, 500 West Balti-       the impact of the WHO FCTC negation
                                         health warnings.                       more St, Baltimore, MD 21201 (e-mail:         process on global public health. Paper
                                                                                         presented at: the 11th World Confer-
  Despite these early efforts in            The support of the American             This article was accepted January 22,     ence on Tobacco or Health, August 19
support of the FCTC, the pro-            Public Health Association is an        2004.                                         2000, Chicago, Ill.

938 | Global Tobacco Control Issues | Peer Reviewed | Roemer et al.                                   American Journal of Public Health | June 2005, Vol 95, No. 6

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